| NPI | 1306877535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD153262) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2001016822) |
| 207R00000X Internal Medicine (Licence: OR MD153262) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-11-29 |