| NPI | 1578094173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 287563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 63823) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 63823) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-02-24 |