| NPI | 1104282631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 313762) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 183500000X Pharmacist (Licence: NJ 28RI03715600) | |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2022-09-12 |