NPI | 1932514965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME129989) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN 19675) |
Enumeration Date | 2014-06-28 |
Last Update Date | 2022-01-12 |