| NPI | 1043505936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 140958) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P4582) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 261806) | |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2016-11-21 |