| NPI | 1104069897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME126567) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: NY 269108) |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: FL ME126567) | |
| Enumeration Date | 2009-04-11 |
| Last Update Date | 2019-11-05 |