| NPI | 1346323961 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101006386) | 
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101006386) | 
| Enumeration Date | 2006-10-24 | 
| Last Update Date | 2025-08-04 |