| NPI | 1609182898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.132901) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042.0013078) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 53098) | |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2018-07-17 |