| NPI | 1104008606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036131939) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01071600A) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME150399) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57013812) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2021-11-23 |