| NPI | 1235392473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD163929) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD163929) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A104062) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-10-14 |