| NPI | 1619543840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: MN 80005) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT020963) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 80005) | |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2025-06-30 |