| NPI | 1750373882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042.0016633) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35-077505 K) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2023-01-20 |