| NPI | 1205042769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 253089) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 57.011073) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-07-06 |