| NPI | 1659720340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME147633) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX 47496) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: FL ME147633) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-12-02 |