| NPI | 1407010143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD443666) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT193855) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193855) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2012-06-05 |