| NPI | 1053476135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX H7133) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A45348) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX H7133) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-09-10 |