| NPI | 1831628205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 309017-01) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS020688) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018005) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-06-07 |