| NPI | 1265758734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 56394) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 56394) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2014-09-21 |