| NPI | 1225066418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.049517) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C41166) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101253992) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD33125) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-12-28 |