| NPI | 1740629732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S4914) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 58979) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 56394) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2020-06-16 |