| NPI | 1447231352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101274847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055246A) |
| 207Q00000X Family Medicine (Licence: WV 32546) | |
| 207Q00000X Family Medicine (Licence: VA 0101274847) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01055246A) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 32546) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2024-12-24 |