| NPI | 1659594562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR A006158) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A006158) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-11-22 |