| NPI | 1861786576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R6055) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35126162) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 48242) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2018-11-19 |