NPI | 1255745477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 291509) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 259895) |
Enumeration Date | 2014-06-16 |
Last Update Date | 2020-12-28 |