| NPI | 1851438345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD 20804- PT) |
| Additional Taxonomies | 111NR0400X (Licence: MD 03390) |
| 204R00000X Electrodiagnostic Medicine (Licence: MD 20804) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-08-29 |