| NPI | 1396190971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.142531) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 58417) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2021-06-29 |