| 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 |