| NPI | 1710447255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13848425-1205) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-09805) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2023025341) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-07-11 |