| NPI | 1700189792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 19290) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: CO 19290) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2010-12-13 |