| NPI | 1497740930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MI 4301062800) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-127636) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301062800) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2023-02-07 |