| NPI | 1336415306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2017-00544) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 127584) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2019-12-20 |