| NPI | 1285731513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 13235) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 13235) |
| 2084P0805X (Licence: WV 13235) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-04-06 |