| NPI | 1942410667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.125820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301119245) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2026-07-02 |