| NPI | 1073827275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301104208) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH Acknowledgement Let) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2022-08-04 |