| NPI | 1356872063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME148855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN25045) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD215916) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U5383) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-05-17 |