| NPI | 1104118918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q5161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q5161) |
| 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: TX Q5161) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101275499) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2024-11-04 |