| NPI | 1780791913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX G3203) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-03-18 |