| NPI | 1679005797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD472395) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63936) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-08-01 |