| NPI | 1205062361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL OS19209) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR DO168314) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023030138) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2023-12-28 |