| NPI | 1982858239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 83282) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 27835) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME154182) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2026-08-20 |