| NPI | 1346565686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN MD51067) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301110944) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.129025) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2021-12-17 |