| NPI | 1306332002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35143661) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216104) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2026-03-16 |