| NPI | 1033521414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA A156544) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD182183) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 29136) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: CA A156544) | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2021-12-22 |