| NPI | 1598762635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34008267) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 2084) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA 050081751) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2024-10-20 |