| NPI | 1215324900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD047575) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A169049) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D86312) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2021-08-13 |