| NPI | 1952382731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 34138) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 34138) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2011-02-08 |