| 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 |