| NPI | 1598862021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 29964) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 29964) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2018-11-30 |