| NPI | 1346538493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 134890) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2011019293) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 284868) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2017-10-17 |