| NPI | 1730479049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: PA MD453946) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT198780) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT198780) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2015-05-04 |