| NPI | 1851503155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A116581) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 57.012387) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 243199) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-12-01 |