| NPI | 1801187794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 00141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-00141) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2021-05-26 |