| NPI | 1174867980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301507082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 272106) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01083954A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2022-07-19 |