| NPI | 1639468465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-14923) |
| Additional Taxonomies | 208D00000X General Practice (Licence: UT 9083415-1205) |
| 208D00000X General Practice (Licence: NM MD2016-0610) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2019-12-31 |