| NPI | 1497323091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5315266831) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 4351049009) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2026-04-22 |