| NPI | 1164537759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI DOS1121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-1121) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-02-14 |