NPI | 1790096998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S3828) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 86564) |
2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2020-04541) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2010017737) | |
2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 61514) | |
Enumeration Date | 2010-06-23 |
Last Update Date | 2023-12-12 |