| NPI | 1215913116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 12961) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: HI 12961) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |