| NPI | 1235336199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 32694) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 098882) | |
| 207R00000X Internal Medicine (Licence: WV 24492) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2013-08-06 |