| NPI | 1972759082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.099843) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2014009231) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 63145) | |
| Enumeration Date | 2008-08-09 |
| Last Update Date | 2025-09-08 |