| NPI | 1063224160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084E0001X (Licence: IA SP-0305) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: IA SP-0305) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: IA SP-0305) | |
| Enumeration Date | 2025-01-24 |
| Last Update Date | 2025-04-28 |