| NPI | 1679915110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: CT 56722) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 56722) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2022-07-21 |