| NPI | 1538627179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 71792) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MT MED-PHYS-LIC-127635) | |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2023-07-25 |