| NPI | 1649769910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX 47981) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 94516) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 72913) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2023-07-07 |