| NPI | 1194968024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R5234) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 265699) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 62799) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2018-06-06 |