| NPI | 1518385137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 308955) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: LA 308955) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2021-03-30 |