| NPI | 1881670404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G1969) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX G1969) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-09-07 |