| NPI | 1114362613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 309584) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.147040) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME160286) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD473996) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U5665) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2024-04-05 |