| NPI | 1750796785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S9089) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 309971) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2021-04-06 |