| NPI | 1902875743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 20859) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: WV 20859) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.095675) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2022-10-13 |