| NPI | 1659418267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10366261-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 10366261-8905) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 75589) | |
| 261Q00000X Clinic/Center (Licence: OR MD125756) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD125756) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-11-13 |