| NPI | 1992232144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0062999) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO PHA.0019448) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0062999) | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2022-07-21 |