NPI | 1316500457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1015086) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT217450) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD475135) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-15 |
Last Update Date | 2024-06-03 |