| NPI | 1215249537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125058868) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 57435-20) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: MI 4301105187) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2015-01-26 |