| NPI | 1689017550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-12545) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 78012) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD461275) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35127873) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2025-05-16 |