| NPI | 1386873073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 48490) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 35.137125) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX BP1-0039174) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2022-05-20 |