| NPI | 1699017129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 74073) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IL 126.063101) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2020-12-07 |