| NPI | 1619138468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A117141) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 251565) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R0769) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2022-05-19 |