| NPI | 1356734446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 323919) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 323919) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 243554) | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2020-10-13 |