| NPI | 1780796722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 01075325A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 034451) |
| 174400000X Specialist (Licence: OH 04451) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-05-18 |