| NPI | 1417193087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MI 4301104031) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-01-01 |
| Last Update Date | 2014-01-30 |