| NPI | 1861470205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 29035) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C30587) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-03-0167-S) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2012-05-19 |