| NPI | 1679002497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.141899) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101285181) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 60646) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4351028739) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2026-08-12 |