| NPI | 1003103706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME126337) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: MD D0073954) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA09271100) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2022-08-26 |