| NPI | 1578213823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4351049829) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX V3293) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2024-09-25 |