| NPI | 1720140536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 26838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 26838-020) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2015-05-07 |