| NPI | 1942567060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 85414) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: SD 10669) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2020-12-08 |