| NPI | 1588027403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 66461) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 66461) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 94706) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA 94706) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2024-11-27 |