| NPI | 1255622015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101268956) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2016-01188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2023-06-15 |