| NPI | 1083019574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR DO209910) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA OP61276957) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34.014066) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2025-06-09 |