| NPI | 1154588267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301109307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301109307) |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2023-06-21 |