| NPI | 1245684075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.151758) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 172135) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2021-0207) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-88129) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2025-07-15 |