| NPI | 1659317360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9400753) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101262477) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9400753) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-09-23 |