| NPI | 1578546438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NM MD2011-0547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2011-0547) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2022-10-21 |