| NPI | 1891128732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 0514417) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL OS14417) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: U03433) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL U03433) | |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2020-08-11 |