| NPI | 1942931852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2026011620) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 2026011620) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2026-04-22 |