| NPI | 1487706099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 7821510-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD 60082250) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD 29092) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 241524) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-06-21 |