| NPI | 1245582345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S0535) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0116025291) |
| 208D00000X General Practice (Licence: HI MD-16928) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2019-04-25 |