| NPI | 1043448582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NC 201300674) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 201300674) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 157148) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-09-09 |