| NPI | 1467642165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SD 8265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: SD 8265) | |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2012-08-01 |