| NPI | 1598269565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VT 042.0015843) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VT 060-0004762) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2022-05-26 |