NPI | 1093164170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A17184) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL UO5012) |
208D00000X General Practice (Licence: FL UO 5012) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-06-08 |
Last Update Date | 2019-10-31 |