| NPI | 1407315864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 18239) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC DO91264) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2023045462) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34.016741) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0548697) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 202304562) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX U5391) | |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2024-04-18 |