| NPI | 1609051630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.092713) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 060205) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2011-07-12 |