| NPI | 1194926394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35084827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35084827) |
| 207Q00000X Family Medicine (Licence: CA A100436) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A100436) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-02-22 |