| NPI | 1205121126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD452512) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT200502) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200502) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2016-05-02 |