| NPI | 1619072659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.03967) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 9518630) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-11-17 |