| NPI | 1174766216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 254858) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 254858) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 048420) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2021-04-02 |