| NPI | 1679569222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: OH 35083960) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301072814) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2009-02-06 |