| NPI | 1265588842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60265929) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A99733) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1461) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2017-10-19 |