| NPI | 1710034095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 300857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01063076A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 01063076A) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01063076A) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2016-01-27 |