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 |