| NPI | 1619458676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD477620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC009876) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT215100) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2023-05-18 |