NPI | 1134654007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A157695) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
174400000X Specialist (Licence: CA A157695) | |
Enumeration Date | 2017-04-27 |
Last Update Date | 2024-04-03 |