| NPI | 1700175312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A133131) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD60844128) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: WA MD60844128) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2023-12-01 |