| NPI | 1083959373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101263315) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0116027871) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116027871) | |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2023-11-27 |