| NPI | 1770738353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 26615) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 18930) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2019-08-02 |