| NPI | 1881128320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY C3947) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME151830) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD226036) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD70001081) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL P620800883740) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-07-01 |