| NPI | 1487834362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX P9512) |
| Additional Taxonomies | 2084H0002X (Licence: TX P9512) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: TX P9512) | |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TX P9512) | |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2023-12-10 |