| NPI | 1508860230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL 21172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 21172) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200600548) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2023-03-07 |