| NPI | 1285082164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 032-0133958) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 297420) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2021-11-17 |