| NPI | 1508903436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 122628) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OR MD24707) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MS 13160) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-04-21 |