| NPI | 1063401412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 34.007242) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34 007242) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2025-08-01 |