| NPI | 1316591258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD480011) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ P20-00224) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2023-08-18 |