| NPI | 1164618583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N1772) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX N1772) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX N1772) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2013-07-30 |