| NPI | 1669091005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-51060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-51060) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2025-06-30 |