| NPI | 1164833281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: WV 27653) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 27653) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2021-06-25 |