| NPI | 1952538183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2018039246) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS12239) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2019-06-03 |