| NPI | 1023499621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2020-03057) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-03057) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2024-07-15 |