| NPI | 1265871578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60844563) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60844563) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT203556) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2021-05-25 |