| NPI | 1932184017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 41417) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 36435) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 36435) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2024-03-11 |