| NPI | 1023139805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 53047-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53047-20) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-06-24 |