| NPI | 1164957452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD213717) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME158985) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP10074771) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2022050067) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2023-08-29 |