| NPI | 1366975989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U3550) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 300866) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61477979) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-09-27 |