| NPI | 1780768085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35081530) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM TM2018-0208) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-10-18 |