| NPI | 1467566745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-062816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.062816) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2015-12-31 |