| NPI | 1912332933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-13650) |
| Additional Taxonomies | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: FL PS47903) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-13650) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2025-07-10 |