| NPI | 1013295682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SD 9693) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SD 0108) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2015-11-10 |