NPI | 1124225677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101246986) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019539) |
Enumeration Date | 2007-06-28 |
Last Update Date | 2012-11-09 |