| NPI | 1407888704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 025735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 025735) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2014-03-07 |