| NPI | 1194346155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 38256) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 38256) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2023-10-17 |