| NPI | 1972761070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME144823) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A121700) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301092144) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301092144) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195379) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT195379) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2026-01-02 |