| NPI | 1841386612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.045859) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 25679) |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: OH 35-045859) | |
| 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: KY 25679) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-08-15 |