| NPI | 1356645717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036134428) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT196687) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-133335) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2018-07-05 |