| NPI | 1346827078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0017159) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH R3753) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2023-09-01 |