| NPI | 1508867789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 35348) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: TN 35348) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35128980) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-03-25 |