| NPI | 1720050347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX E2904) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: TX E2904) |
| 208D00000X General Practice (Licence: TX E2904) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX E-2907) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-07-06 |