| NPI | 1144316506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35070169) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 054050) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 279672) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-04-30 |