NPI | 1982961009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 330305) |
Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: MD D82627) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MD D82627) | |
Enumeration Date | 2012-04-13 |
Last Update Date | 2022-08-22 |