| NPI | 1912550450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 57.250202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT219536) |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: NY 321814-01) | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2023-04-18 |