| NPI | 1841619327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101272193) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101272193) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 291420) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-01-05 |