| NPI | 1437133535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 03372) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 34-007773) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2022-10-13 |