| NPI | 1396321832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W3304) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 337164) |
| 207R00000X Internal Medicine (Licence: TX W3304) | |
| 207R00000X Internal Medicine (Licence: LA 337164) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-07-15 |