| NPI | 1629411368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DC MD042862) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MD D0079501) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2024-01-26 |