| NPI | 1063049401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AR E-19201) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-19201) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: LA 328225) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-07-24 |