| NPI | 1265849640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME127551) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 281678) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2018-03-28 |