| NPI | 1154357366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD21353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD21353) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-10-06 |