| NPI | 1124173026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301093239) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD427264) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: MI 4301093239) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2019-06-26 |