| NPI | 1124285499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: SD 8439) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2018-10-11 |