| NPI | 1972687093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX M5062) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN MD33847) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: TX M5062) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-04-02 |