| NPI | 1467510990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX G4190) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX G4190) |
| 207R00000X Internal Medicine (Licence: TX G4190) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-02-10 |