| NPI | 1033353081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 25730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116022715) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2014-09-18 |