| NPI | 1336103571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.123991) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 13483) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WV 13483) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2018-06-19 |