| NPI | 1538489489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 284084-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 258493) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301096211) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301096211) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2021-03-17 |