| NPI | 1114026721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.071065) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH T-0818) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH LT3560) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD052597L) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301116510) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-12-06 |