| NPI | 1629347182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME138827) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD460854) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT204799) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: PA MD460854) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10276247-1205) | |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2022-07-21 |