| NPI | 1083923577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.098602) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM RS2008-0424) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2012-06-25 |