| NPI | 1407341506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036.161138) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT216734) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2022-07-01 |