| NPI | 1902067408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R6973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R6973) |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: TX R6973) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: TX R6973) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2022-02-10 |