| NPI | 1083933212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0012929) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 16627) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2014-12-01 |