| NPI | 1598076705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KY 51657) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2010020458) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 51657) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2022-07-19 |