| NPI | 1790736262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 58922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 58922) |
| 103T00000X Psychologist (Licence: GA PSY004241) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN122655) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-10-31 |