| NPI | 1720278914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: OH 35.094367) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 35.094367) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.094367) | |
| 208D00000X General Practice (Licence: OH 35.094367) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2021-10-17 |