| NPI | 1184980583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R4135) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 282409) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63252) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2018-04-11 |