| NPI | 1932309325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 202.425) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: LA 202.425) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 60854477) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-048690) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2018-10-05 |