| NPI | 1619314705 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME160438) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD214135) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA10293600) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023023481) | |
| 208M00000X Hospitalist (Licence: FL ME160438) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-29 | 
| Last Update Date | 2025-06-13 |