| NPI | 1619285442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T7252) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57.017573) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036-135837) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2022-06-23 |