| NPI | 1619436474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME163526) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2023050076) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 129103) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD220486) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN28844) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-11-19 |