| NPI | 1396795530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61082321) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35-085402) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 234311) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2022-07-21 |