| NPI | 1215389473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024015757) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 54883) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ 08247058) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-06-20 |