| NPI | 1356780514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 00000000000000000000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017409A) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2017-04-06 |