| NPI | 1124348370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: TX T3519) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM 1124348370) |
| 101Y00000X Counselor | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A155720) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T3519) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX T3519) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-03-07 |