| NPI | 1619314705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA10293600) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023023481) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME160438) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2023-08-29 |