| NPI | 1720027725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M4517) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 022506) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 32901) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G22323) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI MD-12984) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2004-0221) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2023-10-26 |