| NPI | 1831185545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-062208) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 67932) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI EMC0005754) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY C1406) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-12-09 |