| NPI | 1801019534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA a111247) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R6903) |
| 207R00000X Internal Medicine (Licence: IA 37227) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 37227) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-08-04 |