| NPI | 1720247604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX G8518) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX G8518) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2016-08-31 |