| NPI | 1497216865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 3013924) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IL 125.073600) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.073600) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-05-12 |