| NPI | 1366882409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 71782) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-061750) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 67747) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-05-29 |