| NPI | 1720379845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA10292400) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A125634) | |
| Enumeration Date | 2011-04-23 |
| Last Update Date | 2024-01-08 |