| NPI | 1992239669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 2023-00970) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 305326) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AZ 68504) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 92166) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-01-24 |