| NPI | 1629050588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00031357) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-6393) |
| 207R00000X Internal Medicine (Licence: WA MD 00031357) | |
| 207R00000X Internal Medicine (Licence: ID M-6393) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2015-03-02 |