| NPI | 1710515465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0099658) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64261) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-04-29 |