| NPI | 1972697746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 20584) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 20584) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-12-10 |