| NPI | 1407290307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60832496) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R2150) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2022-07-21 |