| NPI | 1750011698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 41428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021045674) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-06-19 |