| NPI | 1467035527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS025156) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA OS025156) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT020693) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-09-02 |