| NPI | 1093980617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A116035) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 57.012718) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2022-08-11 |