| NPI | 1073000550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 316009) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME162429) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2023-06-11 |