| NPI | 1891824116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 17437) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA 60001088) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.091518) | |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2017-02-04 |