| NPI | 1558479410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P9869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P9869) |
| 207R00000X Internal Medicine (Licence: SC 20889) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 20889) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 36463) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-01-20 |