| NPI | 1174150627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 331423) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64284) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-08-30 |