| NPI | 1336341940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 53136) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35085835) |
| 209800000X Legal Medicine (Licence: OH 35.085835) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: OH 35.085835) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-04-15 |