| NPI | 1518931278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME119195) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G73761) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.056553) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2023-08-10 |