| NPI | 1346565736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME153219) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 11629A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY TL4390) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 36088) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2022-01-05 |