| NPI | 1871655019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 04-17129) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 04-17129) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2011-09-29 |