| NPI | 1235756115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0116034472) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116034472) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2024-05-17 |