| NPI | 1053346908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 347) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: LA 347) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-09-12 |