| NPI | 1649764291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 76643) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 33187) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT215931) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 65946) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-06-13 |