| NPI | 1366927394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD486216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT225602) |
| 106S00000X Behavior Technician | |
| 208D00000X General Practice (Licence: MO 2018035241) | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2024-10-01 |