| NPI | 1952513830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 32683) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 32683) |
| 103T00000X Psychologist (Licence: OH 35.092861) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 57012621) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC mmd.32683TL) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2019-09-18 |