| NPI | 1043779036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 13004911-1204) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX T0917) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-07-11 |