| NPI | 1952373268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 35037906) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 17079) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2013-05-01 |