| NPI | 1639556194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 303384) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NY 303384) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2021-03-25 |