| NPI | 1831624774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 57673) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.142682) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2025-08-19 |