| NPI | 1508418153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME139605) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: FL ME139605) |
| Enumeration Date | 2019-07-14 |
| Last Update Date | 2020-05-07 |