| NPI | 1275630717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: TX K5186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME72252) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME72252) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2025-06-10 |