| NPI | 1942442512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 32717) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 7770254-1205) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX Q0522) | |
| Enumeration Date | 2009-03-29 |
| Last Update Date | 2023-06-27 |