| NPI | 1104932979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 14703) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study (Licence: OH 35074689) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-09-17 |