| NPI | 1063658524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P4438) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TX P4438) |
| 208D00000X General Practice (Licence: TX P4438) | |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2019-05-27 |