| NPI | 1205103793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MI 4301102181) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01082325A) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301102181) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.136853) | |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2025-05-19 |