| NPI | 1386865111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.094483) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME175837) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2026-03-10 |