| NPI | 1699253591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 62206) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD17653) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A157572) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2021-05-28 |