| NPI | 1033407986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A134285) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 7688) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 27327) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 130497) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2017-03-11 |