| NPI | 1538377981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 87152) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 21295) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018797) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2023-01-18 |