| NPI | 1558624841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101259548) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301101472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-07-21 |