NPI | 1063536712 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO DR.0054317) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34-004168) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2021-03-11 |