| NPI | 1679835615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CO DR.0064502) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: SD 10033) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 565422) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2021-06-17 |