| NPI | 1003898495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 102804) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301510506) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME157686) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101281040) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 317259) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.055167) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61440922) | |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2025-01-02 |