| NPI | 1952797805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2020040266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0440938) |
| 207R00000X Internal Medicine (Licence: MO 2020040266) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0440938) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-08-24 |