| NPI | 1205218757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12301900) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MD D84924) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209825) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-09-03 |