| NPI | 1811211253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 009364) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC DO034630) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 05-35327) | |
| Enumeration Date | 2010-03-14 |
| Last Update Date | 2022-11-10 |