| NPI | 1144325341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 36403) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.140167) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 33863) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2026-01-01 |