| NPI | 1376717744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01065489A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49780-20) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57.012438) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2020-01-27 |