| NPI | 1336103407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101042255) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101042255) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-02-04 |