NPI | 1578149423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 337642-01) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 1019214) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-03-22 |
Last Update Date | 2025-07-25 |