| NPI | 1942317060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.087057) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35087057) |
| 208000000X Pediatrics (Licence: OH 35087057) | |
| 207R00000X Internal Medicine (Licence: OH 35.087057) | |
| 208000000X Pediatrics (Licence: OH 35.087057) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2014-09-08 |