| NPI | 1235504572 |
|---|---|
| Former Name | TIMOTHY JOSEPH JOHNSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD479574) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 319784) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.148944) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD61328074) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A197043) | |
| Enumeration Date | 2015-12-12 |
| Last Update Date | 2025-04-15 |