| NPI | 1376574871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 10584) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT 10584) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-05-16 |