| NPI | 1356865208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T5183) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 305463) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 67561) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-08-10 |