| NPI | 1720617244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2023019837) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 76588) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 76588) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-06-19 |