| NPI | 1487888673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 258596) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 258596) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2023-04-20 |