| NPI | 1477546075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX L4158) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: TX L4158) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2013-07-04 |