| NPI | 1114910361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35067827) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 376J00000X Homemaker | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-08-25 |