| NPI | 1508876491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 23670) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.063424) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.063424) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2012-02-29 |