| NPI | 1578983581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301115211) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 71724) |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MI 4301115211) | |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: MI 4301115211) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: MI 4301115211) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2022-07-22 |