| NPI | 1063907046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD480514) |
| Additional Taxonomies | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: PA MD480514) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301116003) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-11-10 |