| NPI | 1770745044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101262272) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-5482) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2019-08-26 |