| NPI | 1811985062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01082994A) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK OK20542) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX K1056) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2024-06-03 |