| NPI | 1740690023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX S0172) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301105172) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105172) | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2020-10-15 |