| NPI | 1457643637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 34.013478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013478) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34.013478) | |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2020-09-23 |