| NPI | 1972510568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH 0001123) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: OH 0001123) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-07-03 |