| NPI | 1073503819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA G19638) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 029918) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: CO 16797) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-03-07 |