| NPI | 1740767599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME169884) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071125) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.150998) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2024-08-21 |