| NPI | 1699137364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: OH 34.014272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014272) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2021-06-16 |