| NPI | 1760427389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 04-18225) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: KS 04-18225) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: KS 04-18225) | |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: KS 04-18225) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2016-01-28 |