| NPI | 1316114184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60136125) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OH 57.010815) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2021-05-04 |