| NPI | 1528042660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV DO2446) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34002343) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2019-08-23 |