| NPI | 1265811152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology Vascular Neurology (Licence: FL OS16556) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL OS16556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2021-02-12 |