| NPI | 1033197645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 25481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 25481) |
| 208D00000X General Practice (Licence: NC 25481) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2019-02-28 |