NPI | 1407380074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD476286) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD476286) |
Enumeration Date | 2017-04-20 |
Last Update Date | 2024-01-25 |