| NPI | 1407264203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A146559) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.133943) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD196684) | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2021-08-11 |