| NPI | 1073953683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD213874) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023006297) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME159343) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042.0013777) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2023-08-29 |