| NPI | 1487234266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 012552) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0600X (Licence: IL 125.085163) | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2026-08-04 |