| NPI | 1598343915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO Dr.0078147) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 34.018762) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-08-18 |