| NPI | 1003855545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G61181) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 35053888) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-04-20 |