| NPI | 1184890063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 6814121-1204) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A11500) |
| 208000000X Pediatrics (Licence: CA 20A11500) | |
| 208000000X Pediatrics (Licence: TX H1137) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2019-07-19 |