| NPI | 1922261080 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 003856-1) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD466040) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57011653) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-09-24 |