| NPI | 1740540921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D83345) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD D83345) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2022-03-08 |