NPI | 1114138633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301102250) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 096664) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD437912) | |
Enumeration Date | 2007-05-25 |
Last Update Date | 2019-01-08 |