| NPI | 1093756074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.024557) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N5158) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0053879) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.024557) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N5158) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-07-11 |