| NPI | 1609042316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 35 126529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 141351) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2018-01-30 |