| NPI | 1295763795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D94571) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-087235) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 54592) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM MD2022-0116) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-06-13 |