| NPI | 1487846945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR MD218985) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.124364) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD00029463) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2026-02-24 |