| NPI | 1881868826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 55568) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 069774) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 106389) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57011397) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-10-29 |