| NPI | 1114001310 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.032638) | 
| Additional Taxonomies | 2084S0012X Psychiatry & Neurology, Sleep Medicine (Licence: OH 35.032638) | 
| Enumeration Date | 2006-10-24 | 
| Last Update Date | 2017-03-10 |