NPI | 1548794399 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 82338) |
Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A18404) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-04-19 |
Last Update Date | 2022-03-10 |