| NPI | 1629509054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: VA 0102208047) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63918) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-11-22 |