| NPI | 1063597961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q0938) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 183156) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 70818) | |
| 282N00000X General Acute Care Hospital (Licence: CA g80603) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2023-11-06 |