| NPI | 1043847825 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 339440) | 
| Enumeration Date | 2020-03-24 | 
| Last Update Date | 2025-10-31 |