| NPI | 1033853767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT021569) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OT021569) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-04-27 |