NPI | 1902875743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 20859) |
Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WV 20859) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.095675) | |
Enumeration Date | 2006-03-15 |
Last Update Date | 2022-10-13 |