| NPI | 1922365584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35127295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35127295) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2020-11-02 |