| NPI | 1285976332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME135837) |
| Additional Taxonomies | 2084N0008X Psychiatry & Neurology Neuromuscular Medicine (Licence: FL ME135837) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2020-09-01 |