| NPI | 1033305941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 54390-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN FE0041082-0027) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2024-01-10 |