| NPI | 1912439670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD61173673) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AL MD.38903) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-06-21 |