| NPI | 1891113841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35-127941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH In Process.) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2017-09-22 |