| NPI | 1699969725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.048359) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D27031) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX G9800) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2007-08-31 |