| NPI | 1073615704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CO DR.0030103) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: CO 0030103) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2019-08-15 |