| NPI | 1336333590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ND 11453) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD463599) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101283782) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2024-10-28 |