| 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 |