| NPI | 1306044524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR 179396) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 179396) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2025-07-04 |