| NPI | 1760801112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD213893) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 115714) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.134710) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023013898) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-08-29 |