| NPI | 1497949440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 265303) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: TX P0247) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2022-05-31 |