| NPI | 1174963888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD468891) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 36050) |
| 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: PA MD468891) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 36050) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2021-07-21 |