| NPI | 1821406232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.155569) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 291456) |
| 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: MA 291456) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MA 291456) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2026-07-07 |