| NPI | 1992027809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301102378) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MI 4301102378) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2020-02-21 |