| NPI | 1235180779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.096545) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 46791020) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036115372) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2019-11-20 |