| NPI | 1356705891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S7594) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: TX S7594) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2019-0114) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-03-06 |