| NPI | 1649919416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101288866) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD489859) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA HS000009L) | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2026-03-31 |