| NPI | 1023571825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX V6309) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.248090) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.150541) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-02-24 |