| NPI | 1043365364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD23069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD23069) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-07-21 |