| NPI | 1174514657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MO 2013022890) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 46702) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MO 2013022890) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: KY 46702) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MO 2013022890) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: KY 46702) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2018-12-25 |