| NPI | 1447456884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD H85783) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 60 249556) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 48623) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2020-09-01 |