| NPI | 1700873627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX L5597) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L5597) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: TX L5597) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-11-29 |