| NPI | 1891704714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME59772) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L4124) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 11788) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: NV 11788) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-09-09 |