| NPI | 1699138495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX T2396) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2019020876) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: TX T2396) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MO 2019020876) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-02-01 |