| NPI | 1285900415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 032.0100830) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2021-12-16 |