| NPI | 1962896241 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: TX u2502)  | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: TX U2502)  | |
| Enumeration Date | 2015-03-24 | 
| Last Update Date | 2025-07-09 |