| NPI | 1841419165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-095811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35095811) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2023-03-21 |