| NPI | 1194347716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5101026645) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 331186) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34.017387) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2024-08-19 |