| NPI | 1396272035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CO DR.0068561) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10059574) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2022-06-14 |