| NPI | 1609300672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0064575) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 310207-01) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A173302) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME151341) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2021-09-24 |