| NPI | 1356792758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 179040) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 278739) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 278739) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA A179040) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2016021108) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-02-22 |