| NPI | 1982863155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD446519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 189268) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2021-11-15 |