| NPI | 1174624035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 48922) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9801208) |
| 207R00000X Internal Medicine (Licence: WI 48922) | |
| 207R00000X Internal Medicine (Licence: NC 9801208) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-12-22 |