| NPI | 1548677974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 60636) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA09738800) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 279149) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 279149) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2019-02-18 |