| NPI | 1861071417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 87272-20) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.148761) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: WI 87272-20) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-09-14 |