| NPI | 1952699522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX T5360) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 125059587) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57.022255) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2022-06-03 |