| NPI | 1902086184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 260791) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC TL34814) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 260791) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2023-05-17 |