| NPI | 1891772125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35071599) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35071599) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2026-06-11 |