| NPI | 1265498604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 095355) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WV 23994) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: IN 01043948A) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2022-02-25 |