| NPI | 1700896073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 42005) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 42005) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: OH 42005) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2010-11-18 |