| NPI | 1740720432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 210589-1) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NY 210589-1) |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: NY 210589-1) | |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |