| NPI | 1699385096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: KY 60597) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 60597) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.249752) | |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2025-05-06 |