| NPI | 1134474943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 284526) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042.0014005) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2018-06-07 |