| NPI | 1801186861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 275230-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT198793) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT198793) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2016-11-16 |