| NPI | 1326096801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME110371) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 30.075303) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 35.075303) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2014-02-03 |