| NPI | 1366974909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 317075-01) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 66477) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 63234) | |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2022-12-16 |