| NPI | 1194059592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 390200000XPsychiatry) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |