NPI | 1083876809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 262429) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE C7-0003982) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: DE C7-0003982) | |
Enumeration Date | 2008-07-02 |
Last Update Date | 2024-05-14 |