| NPI | 1548471964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101247048) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57011631) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2010-11-24 |