| NPI | 1649238221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 0428248) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2000160866) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-10-22 |