| NPI | 1972571768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35-053397) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: OH 35-053397) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-11-29 |