| NPI | 1275962243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301104342) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036144350) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-11-11 |
| Last Update Date | 2024-07-04 |