| NPI | 1679214944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 14280047-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 334147-01) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2026-05-19 |