| NPI | 1679513865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 220035) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD 425502) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 10177) | |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: GA 052786) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-01-06 |