| NPI | 1194169755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 063993) |
| Additional Taxonomies | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: CT 063993) |
| 2085N0700X Radiology, Neuroradiology (Licence: CT 063993) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2020-06-04 |