| NPI | 1639217359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M-13301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA None) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA None) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2023-12-20 |