| NPI | 1619032901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301091601) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MT183845) |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MI 4301091601) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2009-07-21 |