| NPI | 1639512122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17265-I) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 207R00000X Internal Medicine (Licence: PR 17265-I) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2025-06-25 |