| NPI | 1023139581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K1767) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: TX F1767) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-06-24 |