| NPI | 1568997708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: SC 88012) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2022-06-17 |