| NPI | 1386227833 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2025-00022) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 303237) | 
| Enumeration Date | 2021-05-03 | 
| Last Update Date | 2025-07-28 |