| NPI | 1588050892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 307984) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 307984) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2021-07-13 |