| NPI | 1609214832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: TX S8239) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 081847) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10046775) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2021-09-20 |