NPI | 1659543874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C168670) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.119633) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME TD081067) | |
Enumeration Date | 2008-03-27 |
Last Update Date | 2021-06-09 |