| NPI | 1174638712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 37877) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 21008) |
| 208600000X Surgery (Licence: NC 2008-01942) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-04-03 |