| NPI | 1801417241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: WA MD61666299) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076897) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-06-29 |