| NPI | 1558724799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME145683) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NH 22255) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD476365) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MT 100312) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX T3540) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-04-05 |