| NPI | 1548306871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 50927) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 93406) |
| 207R00000X Internal Medicine (Licence: CA G30330) | |
| 207R00000X Internal Medicine (Licence: NV 11010) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM 93406) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G30330) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 11010) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-01-11 |