| NPI | 1710181029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS20177) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 31.005831) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2011036535) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2025-04-16 |