| NPI | 1528161528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 32995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 32995) |
| 207R00000X Internal Medicine (Licence: WV 20982) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 20982) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-07-01 |