| NPI | 1902885502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.127816) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 30392) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD441429) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2022-09-16 |