| NPI | 1831381433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 63677) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 25890) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2016-00930) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2021-06-14 |