NPI | 1396170601 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: FL ME135763) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-40017) |
208D00000X General Practice (Licence: PR 018577) | |
Enumeration Date | 2013-09-05 |
Last Update Date | 2024-06-05 |