| NPI | 1235633397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T5914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T5914) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: TX T5914) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-08-20 |