| NPI | 1003058157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2014-0140) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: PA 207R00000X) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2017-04-17 |