| NPI | 1659304608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.059791) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 31074) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2022-01-03 |