NPI | 1386892404 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 169746) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 329844-01) | |
Enumeration Date | 2008-09-03 |
Last Update Date | 2024-07-30 |