| NPI | 1376536425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 58126) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD18548) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2011-06-16 |