| NPI | 1730370917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35129905) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX FTL43059) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2019-04-01 |