| NPI | 1972573921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA 29828) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WI 52688-020) |
| 2084P0015X Psychiatry & Neurology Psychosomatic Medicine (Licence: IA 29828) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2010-01-19 |