| NPI | 1194087726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD458835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT202375) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202375) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-04-21 |