| NPI | 1457855033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T3650) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 316400) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 13276397-1205) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-05-31 |