| NPI | 1447293147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: OH 35-084998) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-COM-LIC-130) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-04-16 |