| NPI | 1063626273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-17123) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 27110) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 7435) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018607) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101244237) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2013-09-30 |