| NPI | 1003444654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 0010-10530) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MI 5202007565) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2021-05-03 |