| NPI | 1881857043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35093259) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: OH 35.093947) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-03-06 |