| NPI | 1104001189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35-084507) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00047146) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2015-12-17 |