| NPI | 1164409090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 35083993P) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IN 01049357A) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2013-06-12 |