| NPI | 1629416169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301110580) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301110580) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 4301110580) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MI 99999) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110580) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2025-08-01 |