| NPI | 1043912785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14244863-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 12415) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2025-11-13 |