| NPI | 1689889644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD.201344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.201344) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2018-04-04 |