| NPI | 1568921864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME165561) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 70177) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024007335) | |
| 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: TN 70177) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2024-08-19 |