| NPI | 1285016949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 288868) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA MD46516) |
| 207Q00000X Family Medicine (Licence: IA MD46516) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2023-07-06 |