| NPI | 1679951107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MT 141019) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA 60849311) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AK 222922) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2024-11-15 |