| NPI | 1396061339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60562855) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO CDR.0001657) |
| 2084N0600X (Licence: WA MD60562855) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2022-08-23 |