Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
33089
OK
2084P0800X
Psychiatry Physician
341260
NY
2084P0800X
Psychiatry Physician
36463
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
—
Last updated
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