| NPI | 1174772354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P5598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 236439) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 236439) | |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2023-06-14 |