| NPI | 1902255102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R5410) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TX BP10056559) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2022-06-23 |