| NPI | 1184919383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2018-02698) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 26283) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301098253) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2020-10-26 |