| NPI | 1225559016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2021044466) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2021044466) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MT221089) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-06-24 |