| NPI | 1043762115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 8049) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 022507) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX J2488) | |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |