| NPI | 1285883371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301094678) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094678) |
| 282NC0060X General Acute Care Hospital Critical Access | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-014393) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2020-11-23 |