| NPI | 1477866101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD457360) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 107668) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2023-11-27 |