| NPI | 1457512741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 053072) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IL 036127319) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN RP21043) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2014-07-28 |