| NPI | 1730561028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: KY 55152) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 55152) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: KY R3739) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2022-04-26 |