| NPI | 1003227166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023011714) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2023011714) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AR E-9969) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-06-23 |