| NPI | 1114367786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101274705) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2013021034) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D83709) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 57.027218) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-06-16 |