| NPI | 1689968844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX U8901) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: UT 9357053-1205) |
| 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: AZ 67752) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AZ 67752) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 9357053-1205) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2024-03-19 |