| NPI | 1275948648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.136351) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD459075) |
| 207P00000X Emergency Medicine (Licence: PA MT205900) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-12-03 |