| NPI | 1316409394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 343819) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-07-31 |