| NPI | 1013981430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35122307) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD069165L) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-01-25 |