| NPI | 1568090058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301512195) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024032529) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME168230) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD221176) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.151044) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-12-19 |