| NPI | 1578637567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO MDR9140) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: MO MDR9140) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-01-04 |