| NPI | 1508398942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 68958) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 37774) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2021-06-30 |