| NPI | 1346458478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C167815) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 251956) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016255) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-01-22 |