| NPI | 1154685378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 50975) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.128588) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2026-09-02 |