| NPI | 1639179138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 84658) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 36200) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35081499) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 10153479A) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 066426) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2022-12-20 |