| NPI | 1013544097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: OH 35.151556) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4352001005) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.151556) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-08-19 |