| NPI | 1154819332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34.016630) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5101026625) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL UO5906) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2023-08-07 |