| NPI | 1245280437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-15415) |
| Additional Taxonomies | 2084P0805X (Licence: KS 04-15415) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2009-05-01 |