| NPI | 1093903361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K2054) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 32035) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 22397) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 052525) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2006005517) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |