| NPI | 1710941018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35085072) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 34057) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2008-08-29 |