| NPI | 1538512629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S9451) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A177431) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 35013) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 76821) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2024-02-19 |