| NPI | 1770604233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34.012065) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 04017) |
| 2084N0600X (Licence: KY 04017) | |
| 2084N0600X (Licence: OH 34.012065) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2024-07-25 |