| NPI | 1215916143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0422732) |
| Additional Taxonomies | 2084P0805X (Licence: MO R3K75) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO R3K75) | |
| 2084P0805X (Licence: KS 0422732) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2026-07-28 |