| NPI | 1881272912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD.MD.61686970) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG204885) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-07-13 |