| NPI | 1477781433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA 72649) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL DO1183) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 72649) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 72649) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 129858) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2017-12-04 |