NPI | 1548649080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0062021) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60969938) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R8720) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10054454) | |
Enumeration Date | 2015-05-28 |
Last Update Date | 2023-01-30 |