NPI | 1518549328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA 20A22709) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OT020545) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A22709) | |
Enumeration Date | 2021-04-22 |
Last Update Date | 2024-10-28 |