| NPI | 1730393984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 46903) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018582) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036150186) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: VA 0101244644) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-03-07 |