| NPI | 1376804708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP60608490) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101020604) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 9407902) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2016-08-19 |