NPI | 1366026056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 35.150157) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN32811) |
Enumeration Date | 2021-05-08 |
Last Update Date | 2024-09-01 |