| NPI | 1891292025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX S5889) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME163300) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: UT 12256628-1205) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-07-11 |