| NPI | 1548402399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD207459) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A126182) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2015-03-03 |