| NPI | 1629080841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 263345) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35087896) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: OH 35087896) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35087896) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: OH 35087896) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2012-07-24 |