NPI | 1487282422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CT 77357) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-03-27 |
Last Update Date | 2024-07-09 |