| NPI | 1477565539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 10264745-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IN 02004612A) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2018-03-26 |