| NPI | 1912134420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N7936) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX N7936) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2022-11-07 |