| NPI | 1780805176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD192952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301104163) |
| 207Q00000X Family Medicine (Licence: NE 25792) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301104163) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 25792) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-06-10 |