| NPI | 1285746974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX P4982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010922L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-09-01 |