| NPI | 1851733711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101268074) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R2385) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2019047208) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX FK6822200) | |
| Enumeration Date | 2013-07-20 |
| Last Update Date | 2020-06-09 |