| NPI | 1205396892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35.154010) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 57325) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-08-21 |