| NPI | 1306047576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD150292) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WV 22332) |
| 207R00000X Internal Medicine (Licence: OR MD150292) | |
| 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: OR MD150292) | |
| 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: OR MD150292) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2013-08-27 |