| NPI | 1578619169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: OR MD154923) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: WA MD 60092301) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2012-03-02 |