| NPI | 1386087005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 84085) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 201801971) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101281203) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2024-07-19 |