| NPI | 1770784522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 2011-00331) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2011-00331) |
| 208D00000X General Practice (Licence: NC 2011-00331) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-03-05 |