| NPI | 1700014784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.126760) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2009013411) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P9658) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2020-11-06 |