| NPI | 1417953290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-21187) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: KS 04-21187) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: KS 04-21187) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: KS 04-21187) | |
| Enumeration Date | 2005-06-25 |
| Last Update Date | 2007-07-09 |