| NPI | 1013228980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 254585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.057815) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125.057815) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2018-10-05 |