| NPI | 1285157065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SD 14517) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2019-0357) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-08-09 |