| NPI | 1013370956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101274353) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 301819) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63822) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-09-02 |