| NPI | 1679654149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS22377) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0102201533) |
| 207Q00000X Family Medicine (Licence: VA 0102201533) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102201533) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0102201533) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-08-09 |