| NPI | 1205028321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM 9420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 9420) |
| 207R00000X Internal Medicine (Licence: NM 9420) | |
| 208D00000X General Practice (Licence: NM 9420) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-03-27 |