| NPI | 1669983284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 313756) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD479366) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2025-08-15 |