| NPI | 1124005491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 41407) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 41407) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2020-08-19 |