| NPI | 1811525272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.146520) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.146520) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-01-08 |