| NPI | 1053573287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 12486) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 390200000X) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2021-02-14 |