| NPI | 1093706939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D58681) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0058681) |
| 207R00000X Internal Medicine (Licence: MD D0058681) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-03-22 |