| NPI | 1083902399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2016-01168) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2016-01168) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2023-09-22 |