| NPI | 1265426043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME106479) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 35896-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-06-8896-1) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2022-05-16 |