| NPI | 1255778155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD469918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204483) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-06-15 |