| NPI | 1407820863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD0000038395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000038395) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2017-05-02 |