| NPI | 1982344891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PG216076) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC LL87670) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-06-03 |