| NPI | 1619263985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55432) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 55432) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2019-10-08 |