| NPI | 1275985533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 96832) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX S9028) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 268195) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-12-14 |