| NPI | 1013024793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34-003785) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34-003785) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-09-05 |