| NPI | 1972952943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2021045404) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: MO 2021045404) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-01-13 |