| NPI | 1457490443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0064885) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 00000000) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM 2005-0340) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-24 |