| NPI | 1568660652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 323144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD446997) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M6574) | |
| 207R00000X Internal Medicine (Licence: TX M6574) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2023-07-11 |