| NPI | 1164402772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301061355) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35069937) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2018-05-01 |