| NPI | 1750709143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD465125) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 83051) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.134534) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2023-12-29 |