NPI | 1356865208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX T5183) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 305463) |
2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 67561) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-08-02 |
Last Update Date | 2022-08-10 |