| NPI | 1922189927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200400632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200400632) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-10-16 |