| NPI | 1245449461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2011003940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.011624) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-09-08 |