| NPI | 1255533592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P4609) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 174400000X Specialist (Licence: LA MD.203964) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2015-03-30 |