| NPI | 1225562564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO dr0054056) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME151249) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T1882) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A172612) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 309655) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2025-04-14 |