| NPI | 1750961835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.156428) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 35.156428) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-06-09 |