| NPI | 1578971370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 279259) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 56328) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 56328) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2019-06-12 |