| NPI | 1063621696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301086426) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.093668) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MI 4301086426) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-06-27 |