| NPI | 1184696312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 33639) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 52736) |
| 208D00000X General Practice (Licence: MN 33639) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-10-02 |