| NPI | 1366698060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2013021749) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-07075) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2013-07-19 |