| NPI | 1023226610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 53210) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH TC 57-01-0938) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 90024) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-12-28 |