| NPI | 1750765244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-03495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2020-03495) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2022-01-06 |