| NPI | 1265493605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 557) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC DO557) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-05-14 |