| NPI | 1760831713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301116880) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301116880) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA12021800) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-08-01 |