| NPI | 1730472408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD465942) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NJ 25MA09928600) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TN MD0000053119) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 285520-1) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: PA MD465942) | |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2021-03-17 |