| NPI | 1760970354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD478010) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A165610) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2022-07-01 |