NPI | 1760772164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA C175316) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM RS2011-0350) |
2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: DE C1-0011875) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-04-19 |
Last Update Date | 2025-05-13 |