| NPI | 1134549918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 289458) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NY 289458) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63470) | |
| 2084E0001X (Licence: NY 289458) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2022-05-25 |