| NPI | 1518953413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO r8964) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO r8964) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MO r8964) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MO r8964) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-07-08 |