| NPI | 1023178043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY TL9080) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-5611) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX J5027) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2026-04-06 |