| NPI | 1871762559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA DO.000199) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 48861) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 270410) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2016-07-24 |