| NPI | 1023462447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY TP220) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 319494) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 5429) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34.016147) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2025-10-24 |