| NPI | 1053616722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35139584) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: GA 87165) |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: FL ME143736) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME143736) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 304057) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 87165) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2010-0728) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2023-02-13 |