| NPI | 1730132481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-03293) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 046126) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2022-03293) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-12-22 |