| NPI | 1689773418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 83842) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-069943) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-08-15 |