| NPI | 1942402466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N3703) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: TX N3703) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2010-08-17 |