| NPI | 1265067367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 72146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021024766) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2022-07-15 |