| NPI | 1013024793 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34-003785) | 
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 34.003785) | 
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34-003785) | |
| Enumeration Date | 2006-08-25 | 
| Last Update Date | 2025-05-13 |