| NPI | 1396078549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2016-02179) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57015893) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 67303) | |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2023-04-05 |