| NPI | 1952531204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME119037) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA A124075) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 71582) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194511) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2021-03-31 |