| NPI | 1316505951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 322833) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD475434) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT217685) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-04-17 |