| NPI | 1730746603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME169739) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 202203026) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61544450) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0072546) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024039285) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2024-10-07 |