| NPI | 1255347233 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME69400)  | 
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: FL ME69400)  | 
| Enumeration Date | 2006-07-31 | 
| Last Update Date | 2011-10-21 |