| NPI | 1710947544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 19294) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-075972) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD046128L) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2012-06-11 |