| NPI | 1699753764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M3912) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 0030897) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD16407) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-06-0313) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2021-05-21 |