| NPI | 1316113491 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0600X  (Licence: OH 35089793)  | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35089793)  | 
| Enumeration Date | 2008-05-07 | 
| Last Update Date | 2024-08-02 |