| NPI | 1598962946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX T9237) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI MD-18234) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-06-10 |