| NPI | 1982657235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 89083) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036129270) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35059484A) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 4301097758) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01059042A) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 201202116) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-05-09 |