| NPI | 1033179353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101035362) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101035362) |
| 207R00000X Internal Medicine (Licence: NC 35850) | |
| 207R00000X Internal Medicine (Licence: WV 20942) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 35850) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 20942) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2011-10-14 |