| NPI | 1548791635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.136849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.136849) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2022-06-24 |