| NPI | 1912933755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35055697) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OH 35.055697) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 33803) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2017-11-13 |