| NPI | 1699821207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101272928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101272928) |
| 207Q00000X Family Medicine (Licence: CO 38179) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 38179) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01084720A) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2023-02-02 |