| NPI | 1164912069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD477341) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD20511) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 74326) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2025-09-30 |