| NPI | 1497944375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.131258) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX N2378) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301091143) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2021-08-09 |