| NPI | 1659309516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: VA 0101239393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101239393) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH RT-1598) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD442463) | |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: VT 042.0011742) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2018-03-17 |