| NPI | 1205445202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10070415) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 13567920-1205) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-02-13 |