| NPI | 1841873841 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: UT 14211150-1204) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2021-04-28 | 
| Last Update Date | 2025-04-16 |