| NPI | 1356669337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101270868) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 273356) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD453693) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2025-02-14 |