| NPI | 1851591614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2012026911) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012026911) |
| 207Q00000X Family Medicine (Licence: OK 25855) | |
| 207Q00000X Family Medicine (Licence: MO 2012026911) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2012026911) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2024-10-01 |