| NPI | 1407917792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 2333) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 9440) |
| 207Q00000X Family Medicine (Licence: OK 2333) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX H9426) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL DO-641) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 48464) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101009836) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-10-17 |