| NPI | 1326149121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 14773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 14773) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-03-07 |