| NPI | 1194714469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 42460) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60578578) |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: WA MD60578578) | |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: WI 42460) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2023-08-02 |