| NPI | 1013265677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX R4372) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.125986) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A149584) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2020-04-08 |