| NPI | 1124095906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP61572225) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34007515m) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 1563) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 15.63) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2026-06-16 |