| NPI | 1104813369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35055004) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WV 15535) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2007-07-09 |