| NPI | 1376613141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 1634071205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 1634071205) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-09-29 |