| NPI | 1023757531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2026-01855) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-10931) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-07-23 |