| NPI | 1790947562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N6341) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N6341) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 266130) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2015-07-29 |